<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />

</head>
<body>

<form>
<table>

<tr>
<td>Razão Social</td>
<td><input name="text_razao" type="text" id="text_razao" size="40"></input></td>
</tr>

<tr>
<td>Nome Fantasia</td>
<td><input name="text_nome_fantasia" type="text" id="text_nome_fantasia" size="40"></input></td>
</tr>

<tr>
<td>CNPJ</td>
<td><input name="text_cnpj" type="text" id="text_cnpj"></input></td>
</tr>

<tr>
<td>Inscrição Estadual</td>
<td><input name="text_inscricao_estadual" type="text" id="text_inscricao_estadual" /></td>

<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>Endereço</td>
<td><input name="text_endereco" type="text" id="text_endereco" size="40"/></td>
<td>Cidade</td>
<td><input name="text_cidade" type="text" id="text_cidade" size="15" /></td>

<td>CEP</td>
<td><input name="text_cep" type="text" id="text_cep" size="9"/></td>
<td>UF</td>
<td>
    <select name="combo_uf" id="combo_uf">  
    <option value="--">--</option>  
    <option value="AC">AC</option>  
    <option value="AL">AL</option>  
    <option value="AM">AM</option>  
    <option value="AP">AP</option>  
    <option value="BA">BA</option>  
    <option value="CE">CE</option>  
    <option value="DF">DF</option>  
    <option value="ES">ES</option>  
    <option value="GO">GO</option>  
    <option value="MA">MA</option>  
    <option value="MG">MG</option>  
    <option value="MS">MS</option>  
    <option value="MT">MT</option>  
    <option value="PA">PA</option>  
    <option value="PB">PB</option>  
    <option value="PE">PE</option>  
    <option value="PI">PI</option>  
    <option value="PR">PR</option>  
    <option value="RJ">RJ</option>  
    <option value="RN">RN</option>  
    <option value="RO">RO</option>  
    <option value="RR">RR</option>  
    <option value="RS">RS</option>  
    <option value="SC">SC</option>  
    <option value="SE">SE</option>  
    <option value="SP">SP</option>  
    <option value="TO">TO</option>  
    </select>  

</td>
</tr>


<tr>
<td>Telefone</td>
<td><input name="text_telefone" type="text" id="text_telefone" size="20"></td>
<td>FAX</td>
<td><input name="text_fax" type="text" id="text_fax" size="11"></td>


</tr>
<tr>
<td>Contato1</td>
<td><input name="text_contato1" type="text" id="text_contato1" /></td>

<td>Telefone </td>
<td><input name="text_telefone1" type="text" id="text_telefone1" size="11"/></td>
</tr>

<tr>
<td>Contato2</td>
<td><input name="text_contato2" type="text" id="text_contato2" /></td>

<td>Telefone </td>
<td><input name="text_telefone2" type="text" id="text_telefone2" size="11"/></td>
</tr>
<td height="2"></tr>




</table>

<table>

<tr>
<td>Observações</td>
</tr>
<tr>
<td><textarea name="text_observacoes" cols="60" rows="8" id="text_observacoes"></textarea></td>
</tr>


<tr>
<td>

<input type="button" value="Sair"></input>

<input type="reset" value="Limpar"></input>

<input type="submit" value="Gravar" src="./images/icon_confirm.png"></input> 
</td>

</tr>

</table>

</form>

</body>
</html>